Document Detail


Ischemic stroke survivors' opinion regarding research utilizing exception from informed consent.
MedLine Citation:
PMID:  21921594     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: 'Exception from informed consent for research' (EFIC) is a rigorous procedure regulated by the FDA that requires community assent but allows enrollment without patient or family consent. Recently, several acute stroke trials have explored the use of EFIC to improve enrollment. We obtained ischemic stroke survivors' opinions regarding hypothetical enrollment into a clinical trial at the time of their stroke without personal or proxy consent.
METHODS: During 2005, 460 ischemic stroke patients (or their proxy) who met case criteria were prospectively interviewed and followed. After 2 years, patients were asked to think back to the time of their stroke and indicate whether they would have wished to be enrolled in an acute stroke research study before individual or proxy consent could be obtained, understanding that consent would be sought as soon as possible thereafter, and they rated how agreeable they would have been to acute stroke research with different levels of invasiveness. Predictors of a positive opinion regarding the hypothetical research were analyzed using logistic regression. Variables included in the model were age, race, sex, education, initial NIHSS, modified Rankin Scale prior to stroke and 30 days after stroke, and proxy versus patient responder.
RESULTS: At 2 years after stroke, after excluding patient deaths, missing data or refusals, there were 194 patient/proxy responses included in this analysis. Overall, 72-79% of responses were favorable for chart review or blood draw without consent. The proportions answering agreeably to questions about medications or invasive strategies were smaller (62.9 and 59.8%). Older subjects were less likely to offer an agreeable response regarding use of medications [OR 0.97 per year (95% CI 0.94-0.99)] and invasive procedures [OR 0.97 per year (95% CI 0.94-0.99)]. Nonblacks tended to be more agreeable than blacks to invasive procedures. Men had twice the odds of being agreeable to blood draws than women.
CONCLUSIONS: We found that the majority of interviewed ischemic stroke patients were agreeable to being enrolled in acute stroke research with exception from informed consent, although the rates of agreement were lower than we expected among a cohort of patients who had already agreed to research. Older subjects, black race, and women were less likely to agree to blood draws or treatment strategies.
Authors:
Dawn Kleindorfer; Christopher J Lindsell; Kathleen Alwell; Daniel Woo; Matthew L Flaherty; Jane Eilerman; Pooja Khatri; Opeolu Adeoye; Simona Ferioli; Brett M Kissela
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Publication Detail:
Type:  Journal Article     Date:  2011-09-15
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  32     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2011  
Date Detail:
Created Date:  2011-10-25     Completed Date:  2012-03-22     Revised Date:  2013-08-02    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  321-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 S. Karger AG, Basel.
Affiliation:
University of Cincinnati, Cincinnati, Ohio 45267-0525, USA. dawn.kleindorfer@uc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Aged, 80 and over
Attitude to Health*
Biomedical Research*
Clinical Trials as Topic / psychology*
Continental Population Groups
Female
Humans
Informed Consent / psychology*
Logistic Models
Male
Middle Aged
Prospective Studies
Retrospective Studies
Sex Factors
Stroke*
Survivors / psychology*
Grant Support
ID/Acronym/Agency:
R01 NS030678/NS/NINDS NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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